Say Goodbye to Paper: Web-Based Reporting is Here!

1. Say Goodbye to Paper: Web-Based Reporting is Here! Iris Zachary, MS, CTR, Missouri Cancer Registry

2. This project was supported in part by a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Missouri Department of Health and Senior Services (DHSS) (#U55/CCU721904) and a Surveillance contract between DHSS and the University of Missouri. Acknowledgements • Missouri Cancer Registry: • Nancy Cole, CTR • Sue Vest, CTR • J. Jackson-Thompson, MSPH, PhD MCR Missouri Cancer Registry

3. MCR’s Goals • Offer a web-based reporting mechanism for physicians; • Increase the number of cancer cases reported to the central registry; and • Reduce central registry staff effort.

4. Background • Missouri physicians required to report only if case not reported by another entity • Dermatologists began reporting on paper in 2004 • (> 160 + general surgeons, plastic surgeons, etc.) • Urologists not reporting yet • (> 160)

5. Background • Many types of cancer being diagnosed and treated completely outside the hospital setting • Prostate • Melanoma • Breast • Leukemia

6. Prostate Project with CDC • In 2005, MCR selected as one of 8 central cancer registries (CCRs) to participate in a pilot project. • Purpose: Pilot use of web-based (Web Plus) reporting to increase physician reporting of genitourinary system cancers.

7. What is Web Plus? • Secure, web-based application; • Developed by CDC with input from CCRs; • Offered free of charge to CCRs; • Technical support provided by CDC;

8. Advantages of Web Plus • Software can be modified/enhanced to meet needs of participating CCRs. • Facilities can directly enter data and submit cases on-line.

9. Web Plus • CCR hosts servers • CCR sets up user accounts • Users log directly into CCR server • User can only access his account • Multiple security features

11. Key elements of Web Plus • Customizable features • Create displays for specific cancer sites • Change field names to basic English (PSA value rather than CSSSF 1) • Add help messages specific to a particular cancer site • Set defaults based on cancer site • Make fields invisible • Set critical fields (text, etc.) • Move fields to any position

17. Lessons…. • Physicians are not aware that cancer registries have national standards for codes. • Physicians and staff are overwhelmed by the number of fields

18. Lessons…. • Training needs depend on the person who will be completing electronic forms (physician, RN, medical assistant, etc.) • Familiarity with cancer and cancer reporting terminology (e.g. histology) • Familiarity with chart • Physicians

19. Lessons….. • Labels for items must be changed to plain English (e.g., “CSSSF1” to “PSA value”) • Field labels do not have to be NAACCR field names • Must have CS reference in case of edit errors • Can select critical fields, including text fields • Can customize boxes that offer instructions for completing fields

20. Lessons….the use of text fields • Physician • REDUNDANT!!!! • Unnecessary • I won’t complete • Staff • Way to QA (for CCR and for them) • Makes them think about the codes they’ve chosen

21. Lessons….. • Physicians and staff, though unfamiliar with collaborative staging, actually have enough information to stage cases for certain primary sites • CS fields (extension, lymph nodes, etc.) • CSSSF fields ( PSA values, Gleason’s score, etc.)

22. Lessons…. • Hospital cancer registrars can be your ally • Recruiting physicians • Training staff • Serving as ongoing resource to office staff for questions

23. Summary • Year-long project results: • Urologists were not ready to report on paper or electronically • Web Plus features make it easy to use for a variety of functions • MCR will continue to use Web Plus, with a focus on converting dermatologists from paper to web-based system, then focus on getting cases from urologists

24. Applying what we learned to web-based melanoma reporting

25. PROSTATE One site 1-2 histologies Little diagnostic/treatment coding Biopsy info No surgery, radiation or chemo CS factors Case finding MELANOMA Multiple sites Multiple histologies Confusion about codes for diagnostic procedure vs. surgical procedure Excisional biopsy CS factors Case finding Project differences

26. Decisions • What is the least amount of information we can accept? • How can we make this as easy as possible? • If it is too difficult/time-consuming, they may not report at all.

27. How many fields? • Can we eliminate some? • Default – make invisible? • Default – leave visible (in case they do need to use it)?

28. Use of codes • Can they do it? • All fields • Specific fields • Text

31. Show same slide for melanoma display

32. Show same slide for melanoma display

34. Issues at MCR • Training users • Issuing Passwords (practice vs. individual) • Managing hundreds of accounts • Determining responsibilities and workflow at CCR

35. Web Plus Future Enhancements • CCR can start the form on Web Plus (manually or via an electronic path lab file) • CCR notifies physician that form is waiting to be completed • Physician office staff can log on to Web Plus, complete and release form to CCR

36. Disadvantages of Web-Based reporting • Lose the paper – lose the info contained on the paper • Still labor intensive, but in a different manner • Must develop good tracking systems (FB, etc.) • Managing potentially hundreds of accounts requires attention to detail

37. Advantages of web-based reporting • Process more cases in the same amount of time • No more paper to file • Increased security • Reduce data entry/ error

38. Future uses • Death clearance follow-back • Path lab follow-back • Utilizing e-path files for follow-back

39. MCR Staff Shari El Shoubasi Web Plus Coordinator Toll-free: 866 240-8809 573 884-6928 Email: elshoubasis@health.missouri.edu

40. MCR Staff (cont.) Nancy Cole Non-Hospital Reporting Coordinator Toll-free: 866-240-8809 Phone: 573-884-2491 Email: colen@health.missouri.edu

41. Missouri -- http://mcr.umh.edu/ • https://webplus.umh.edu/webplus • Prostate • User ID: johndoe • Password: test • Melanoma • User ID: janedoe • Password: test